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1.
Bone Joint J ; 96-B(5): 604-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24788493

RESUMO

In 2005, we demonstrated that the polished triple-tapered C-stem at two years had migrated distally and rotated internally. From that series, 33 patients have now been followed radiologically, clinically and by radiostereometric analysis (RSA) for up to ten years. The distal migration within the cement mantle had continued and reached a mean of 2 mm (0.5 to 4.0) at ten years. Internal rotation, also within the cement mantle, was a mean 3.8° (external 1.6° to internal 6.6°) The cement mantle did not show any sign of migration or loosening in relation to the femoral bone. There were no clinical or radiological signs indicating that the migration or rotation within the cement mantle had had any adverse effects for the patients.


Assuntos
Artroplastia de Quadril/efeitos adversos , Migração de Corpo Estranho/etiologia , Prótese de Quadril , Falha de Prótese/etiologia , Idoso , Artroplastia de Quadril/métodos , Cimentação , Progressão da Doença , Feminino , Seguimentos , Migração de Corpo Estranho/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Período Pós-Operatório , Desenho de Prótese , Análise Radioestereométrica , Rotação
2.
J Bone Joint Surg Br ; 87(12): 1631-5, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16326875

RESUMO

We investigated the wear characteristics and clinical performance of four different total hip joint articulations in 114 patients. Wear and migration was measured by roentgenstereophotogrammetric analysis at five years or at the last follow-up. The mean annual wear was 0.11 mm for a stainless steel/Enduron articulation, 0.34 mm for stainless steel/Hylamer cup, 0.17 mm for zirconium oxide ceramic/Enduron and 0.40 mm for zirconium oxide ceramic/Hylamer. The difference between the groups was significant (p < 0.008) except for stainless steel/Hylamer vs zirconium oxide ceramic/Hylamer (p = 0.26). At present, 12 patients have undergone a revision procedure, four at five years and eight thereafter. No patient who received a stainless steel/Enduron articulation at their primary replacement required revision. Conflicting results have been reported about the performance of the zirconium oxide ceramic femoral head, but our findings suggest that it should not be used with a polymethylmethacrylate acetabular component. Hylamer has already been withdrawn from the market.


Assuntos
Artroplastia de Quadril/instrumentação , Cerâmica/uso terapêutico , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Zircônio/uso terapêutico , Idoso , Análise de Variância , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Fotogrametria/métodos , Falha de Prótese , Radiografia
3.
J Clin Microbiol ; 37(8): 2737-9, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10405436

RESUMO

Peptostreptococcus micros is a commensal of the oral cavity and the genitourinary tract that rarely causes serious infections. A case of a destructive knee joint infection with rapid progress caused by P. micros is presented. The significance of the microbiological findings was initially not acknowledged, which contributed to a nonsuccessful clinical outcome.


Assuntos
Infecções por Bactérias Gram-Positivas/microbiologia , Artropatias/microbiologia , Articulações/microbiologia , Peptostreptococcus/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Joelho/microbiologia , Masculino
4.
J Arthroplasty ; 13(8): 935-8, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9880188

RESUMO

Coagulase-negative staphylococci are important agents of infected hip arthroplasties, but sample contamination from the skin flora may confuse the diagnosis. Recovery of multiple identical strains has been regarded as indication of true infection. We have evaluated 29 total hip replacement operations with cultures positive for coagulase-negative staphylococci in a prospective study, 16 with > or = 3 isolates available for strain identity analysis. In 26 episodes, > or = 3 cultures were positive for coagulase-negative staphylococci, but only 19 of them had strong or intermediate clinical evidence of infection. Negative clinical evidence of infection coincided with the absence of a predominating strain according to plasmid profile analysis. A reliable identity analysis may help to rule out infection when multiple cultures are positive in patients who lack clinical evidence of infection.


Assuntos
Prótese de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/microbiologia , Coagulase , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/diagnóstico , Reoperação , Infecções Estafilocócicas/diagnóstico , Staphylococcus/isolamento & purificação
5.
Acta Orthop Scand ; 68(5): 461-5, 1997 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9385247

RESUMO

We followed 23 patients from the primary total hip arthroplasty to revision for a bacteriologically proven deep infection with a low virulent organism. The median time to revision was 14 (4-65) months. During this period, the maximum ESR value was median 50 (22-110) mm and the maximum CRP value was 35 (9-95) mg/L. 25 of the 98 CRP values recorded were normal (< 9 mg/L) and 22/89 ESR values were below 30 mm/h. In 6 patients, all CRP values were below 20 mg/L, but 5 of these patients had an ESR > 30 mm. Before the revision, normal values for both tests were found in only 1 patient. Both normal values and slight-to-moderate increases in ESR and/or CRP are consistent with a low-grade periprosthetic hip infection. We recommend that ESR should be determined preoperatively in all patients scheduled for total hip replacement to establish a baseline.


Assuntos
Artroplastia de Quadril/efeitos adversos , Proteína C-Reativa/análise , Infecções Relacionadas à Prótese/sangue , Idoso , Idoso de 80 Anos ou mais , Artrite/cirurgia , Sedimentação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos
6.
J Arthroplasty ; 12(6): 635-8, 1997 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9306213

RESUMO

The results of total knee arthroplasty were evaluated in 113 patients with gonarthrosis (14 patients with and 99 without prior operation with proximal tibial valgus osteotomy). There was no difference in the final result after follow-up periods of 4-9 years with respect to average Hospital for Special Surgery score. degree of knee flexion, and later knee revisions between the 14 osteotomized and 99 nonosteotomized patients. The average femorotibial angle did not differ between the groups; neither did the average wear of the tibial polyethylene. No difference was found in operative time, but a significantly greater blood loss and other postoperative complications were noted among the previously osteotomized group of patients, indicating a more complicated procedure for the knee arthroplasty operation compared with the nonosteotomized group of patients.


Assuntos
Artroplastia do Joelho , Osteotomia , Idoso , Humanos , Reoperação , Falha de Tratamento
7.
J Bone Joint Surg Br ; 79(3): 374-8, 1997 May.
Artigo em Inglês | MEDLINE | ID: mdl-9180312

RESUMO

We studied the risk of recurrent dislocation in 121 primary and 39 revision Charnley or Charnley hybrid total hip arthroplasties which had been treated for a primary dislocation between 1979 and 1995. Only 35% of these hips had no further dislocation or a revision for instability within one year. The rates of survival gradually declined with time or if a second, third or fourth dislocation occurred. The risk of recurrence was greater in men, but was not related to age, diagnosis, time of the first dislocation or whether the index operation had been a primary or a revision procedure. Operative treatment included 15 reoperations leaving intact components, 50 revisions, and permanent removal of the femoral stem in seven patients. The operation was successful in four patients with reoperations and in 36 who had an exchange procedure within two years. Treatment was successful in 35 of 49 hips in which it was possible to correct a technical error compared with 5 out of 16 hips in which malposition of the components was not seen (p = 0.007).


Assuntos
Luxação do Quadril/cirurgia , Prótese de Quadril , Desenho de Prótese , Falha de Prótese , Idoso , Feminino , Seguimentos , Prótese de Quadril/estatística & dados numéricos , Humanos , Masculino , Prognóstico , Desenho de Prótese/estatística & dados numéricos , Recidiva , Reoperação/estatística & dados numéricos , Fatores de Risco , Análise de Sobrevida , Suécia , Fatores de Tempo
10.
J Arthroplasty ; 11(6): 738-42, 1996 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8884451

RESUMO

One hundred fifty-eight Porous-Coated Anatomic (Howmedica, Rutherford, NJ) primary total knee prostheses were evaluated clinically and radiographically to measure the remaining thickness of the plastic insert. Anteroposterior radiographs were taken with the beam guided parallel to the tibial plate by a fluoroscope. The knees were forced into varus and valgus, and the heights of the medial and lateral joint spaces, respectively, were measured with a digitizing table. Plastic insert wear could be calculated after correction with a magnification error factor, established by dividing the projected width of the tibial plate by the true size of the used component. After a mean follow-up period of 84 months (range, 58-116 months), wear was significantly higher for patients with osteoarthritis than rheumatoid arthritis and was 1.4 mm versus 0.7 mm medially (P < .0001) and 0.7 mm versus 0.4 mm laterally (P = .01). Wear was not correlated to thickness of the plastic insert or length of follow-up period. Young age or varus alignment contributed slightly to the amount of wear.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Prótese do Joelho , Fatores Etários , Idoso , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Falha de Prótese , Radiografia
11.
Acta Orthop Scand ; 67(4): 321-4, 1996 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8792731

RESUMO

During 1973-88, we performed 13 total hip replacements in 11 hemophilia patients, mean age 46 (25-65) years. During the operation, blood loss averaged 920 mL, and a mean of 120,000 units of factor VIII/IX were used. The mean duration of follow-up was 7 (1-16) years. 5 hips became loose within 6 years, and a further one after 13 years. 4 hips were revised, 2 of them due to infection in patients who were also seropositive for HIV. At the latest follow-up, 10 patients were alive. 6 had no hip pain and 7 could walk at least 1,000 meters at a time. Although these results are inferior to those obtained in arthrosis, total hip replacement should be considered in hemophiliac patients.


Assuntos
Hemofilia A/cirurgia , Hemofilia B/cirurgia , Prótese de Quadril , Adulto , Idoso , Perda Sanguínea Cirúrgica , Fator IX/uso terapêutico , Fator VIII/uso terapêutico , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiologia , Humanos , Locomoção , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Radiografia , Amplitude de Movimento Articular , Reoperação
12.
J Bone Joint Surg Br ; 78(1): 85-91, 1996 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8898134

RESUMO

A consecutive series of 30 total hip replacements using a hydroxyapatite (HA)-coated, modular implant (Omnifit) was followed clinically and by roentgen stereophotogrammetric analysis for two years and compared with two control groups, one of 27 cemented Charnley sockets and one of 40 cemented Charnley stems. Omnifit sockets with a central gap between the dome of the socket and the acetabular bone in the postoperative radiographs, migrated less than sockets without such gaps (p = 0.01). After adjustment for patient-related factors (age, gender and weight), no significant difference was found between the two prostheses with respect to micromotion and wear. We conclude that the early fixation of the HA-coated Omnifit prosthesis compares with that of the cemented Charnley prosthesis.


Assuntos
Prótese de Quadril , Falha de Prótese , Adulto , Idoso , Cimentação , Durapatita , Feminino , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Fotogrametria , Radiografia
13.
Biomaterials ; 16(16): 1273-7, 1995 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8589199

RESUMO

A pure titanium cylinder or a piece of bone cement was implanted in each upper tibial metaphysis of 20 rabbits. After 4 months radiograms were taken and 10(4), 10(6), or 10(8) Staphylococcus aureus were injected into each leg through central holes in the implants in three groups of animals. Four weeks later new radiograms, bacteriological and histological biopsies were obtained. Three animals died before the end of the experiment. In animals which received 10(6) or 10(8) S. aureus radiographic signs of infection were found in 11/22 legs with both titanium and bone cement implants. No radiolucent zones developed around the implants. Bacteriological cultures from bone close to the implants were negative in all legs with titanium implants and positive in four legs with cement implants. Seven cultures were negative in spite of radiographic changes. It is concluded that after a proper time for wound healing the bone around unloaded implants of both titanium and bone cement is fairly resistant to infection. In some cases, healing of an infection in the surrounding bone seems possible.


Assuntos
Materiais Biocompatíveis/efeitos adversos , Cimentos Ósseos/efeitos adversos , Próteses e Implantes/efeitos adversos , Infecções Estafilocócicas/etiologia , Titânio/efeitos adversos , Animais , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/etiologia , Doenças Ósseas/patologia , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Osso e Ossos/cirurgia , Feminino , Masculino , Teste de Materiais , Coelhos , Radiografia , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/patologia
15.
Acta Orthop Scand ; 66(3): 220-4, 1995 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7604701

RESUMO

We reviewed after 48 (24-90) months the clinical results in 45 cases of revision hip arthroplasties where an uncemented, long-stem femoral prosthesis (BIAS, Zimmer) had been used. A subgroup of 13 cases was followed with radiostereometric analysis (RSA) for 2 years. 3/45 cases had been revised, another 12 had unsatisfactory pain scores. The median Harris score was 69 (26-99). 12/13 stems migrated; 11 subsided 4.1 (0.4-7.9) mm, and 8 migrated posteriorly 2.9 (1.9-9.6) mm. The poor clinical results and large migrations speak against the use of this prosthesis in revision hip arthroplasty.


Assuntos
Migração de Corpo Estranho/etiologia , Prótese de Quadril/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Prótese de Quadril/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação , Fatores de Tempo
17.
J Bone Joint Surg Br ; 73(3): 430-3, 1991 May.
Artigo em Inglês | MEDLINE | ID: mdl-1670444

RESUMO

Total arthroplasty was performed on 21 congenitally dislocated hips in 18 women. In all cases the femoral head was dislocated cranially at least one-fifth of the height of the pelvis. The components were both cemented, the acetabulum being replaced to its original position. The acetabular roof was reconstructed by bone graft in 13 hips, and trochanteric osteotomy was done in 18 hips. The patients were assessed at a median follow-up time of 7.5 years when their median age was 54 years. Nine patients had been revised or required revision. At follow-up the average functional score (according to Charnley) was 6 for pain, 4 for walking ability and 5 for range of motion. The Harris hip score was 82. The patients' subjective evaluation of their satisfaction with the late results on a visual analogue scale was 93, range 23 to 100. The high loosening rate in such patients demands regular follow-up and preparedness for revision surgery.


Assuntos
Acetábulo/transplante , Luxação Congênita de Quadril/cirurgia , Prótese de Quadril , Osteotomia , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Reabsorção Óssea/diagnóstico por imagem , Reabsorção Óssea/etiologia , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/fisiopatologia , Fraturas do Fêmur/cirurgia , Seguimentos , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/fisiopatologia , Humanos , Corpos Livres Articulares/diagnóstico por imagem , Corpos Livres Articulares/etiologia , Corpos Livres Articulares/fisiopatologia , Corpos Livres Articulares/cirurgia , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Radiografia , Amplitude de Movimento Articular , Recidiva , Reoperação , Caminhada
18.
J Arthroplasty ; 5(2): 127-30, 1990 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-2358811

RESUMO

Air contamination was measured in a down-flow, clean air enclosure during 50 total hip arthroplasties to compare the effect of different scrub suits and operating gowns. In one series, with cotton clothes, the operating gowns used were either disposable nonwoven operating gowns or total body exhaust gowns. With the exhaust gowns the median air contamination, measured as colony-forming units (cfu)/m3, was reduced by about 5 times, to 0.3. In another series, nonwoven operating gowns were used together with scrub suits made of either cotton or one of two types of synthetic materials. The latter two scrub suits were equipped with elastic sealings at the openings. With both of these types the median air contamination, compared to cotton scrub suits, was reduced by about one half, to 0.4 cfu/m3. The authors conclude that both specially designed scrub suits and exhaust gowns can further reduce an already low level of bacterial air contamination in a down-flow, clean air enclosure.


Assuntos
Microbiologia do Ar , Poluição do Ar/prevenção & controle , Prótese de Quadril , Salas Cirúrgicas , Roupa de Proteção/normas , Ambiente Controlado , Gossypium , Humanos , Poliésteres , Politetrafluoretileno , Infecção da Ferida Cirúrgica/prevenção & controle
19.
Acta Orthop Scand ; 61(2): 163-9, 1990 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-2193478

RESUMO

Due to systemic or local antibiotic treatment and other preventive procedures, the incidence of deep hip-prosthetic infections in Scandinavia is less than 1 percent, with the majority hematogenous. Coagulase-negative staphylococci and anaerobes are involved in more than half of the cases. The diagnosis is sometimes difficult; preoperative aspiration often gives misleading results; and granulocyte scanning usually adds valuable information. In deep infection the current strategy is to revise with a two-stage procedure. Revisions should be carried out at specialized centers with bacteriologic competence and sufficient experience with implants.


Assuntos
Infecções Bacterianas/etiologia , Prótese de Quadril/efeitos adversos , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Humanos , Reoperação
20.
Acta Orthop Scand ; 60(6): 664-7, 1989 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-2696322

RESUMO

In a randomized study of 20 total hip arthroplasties, the staff wore shirts and trousers of a fabric impervious to bacteria underneath operating gowns of a non-woven material. Volumetric air sampling demonstrated a low number of colony-forming units with this clothing, further reduced by ultraviolet radiation to below 10 colony-forming units/m3, the upper limit of "ultraclean air," in all the cases (median 2.6, range 1.1-7.1).


Assuntos
Microbiologia do Ar , Vestuário , Articulação do Quadril/cirurgia , Salas Cirúrgicas , Esterilização/métodos , Raios Ultravioleta , Bacillus/isolamento & purificação , Ambiente Controlado , Humanos , Micrococcus/isolamento & purificação , Ensaios Clínicos Controlados Aleatórios como Assunto
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